Various central nervous system side-effects are common
with the use of antiepileptic drug therapy in
patients with epilepsy. Symptoms suggestive of psychosis
in some patients with epilepsy have been attributed
to the use of vigabatrin1, carbamazepine, valproic
acid, ethosuximide2 and phenacemide3. Topiramate
is a highly effective new antiepileptic drug when
used as an adjunctive therapy in patients with refractory
partial seizures. Mild to moderate cognitive impairments
have been described as the main side-effects
of this drug. The incidence of psychosis was not significantly
different among treatment groups compared
to placebo groups in premarketing clinical drug trials.
We discuss five patients treated with topiramate who
developed symptoms of psychosis. These included the
sudden onset of various combinations of paranoid delusions,
auditory hallucinations and a feeling of depersonalization.
Suicidal thoughts, aggressive and agitated
behavior and thoughts, severe mood swings or cognitive
problems were often present as well, but were not
considered evidence of psychosis by themselves.